Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 14410 | NC |
NPI | 1003573759 |
---|---|
Provider Name | Mrs. Jennifer Cody |
First Address | Wake Forest, NC 27587-2568 |
Second Address | Durham, NC 27703-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2021 |
Last Update Date | 17/11/2021 |